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13.00055

THE JOURNAL

OF THE

Michigan State Medical Society

The Official Organ of the State and County Medical Societies

PUBLISHED MONTHLY UNDER THE DIRECTION OF THE COUNCIL

Vol. XI

January to December, 1912

BATTLE CREEK, MICH.

WILFRID HAUGHEY, A.M., M.D., Editor

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LIBRARY 13044

The Journal of the Michigan State Medical Society

PUBLISHED UNDER THE DIRECTION OF THE COUNCIL

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Many theories have been advanced with The ductless glands in the neck can be regard to the special secretion and func- demonstrated in embryos of 4 mm. The tion of the thyroid gland. The various thyroid develops from three anlage, a glands of the body can be classified into superior median in the tongue-bulb, and three groups; protective, digestive and two lower in the fourth branchial groove. eliminative. The thyroid is classed among Failure of complete descent leaves the the protective glands. From investiga- superior portion as lingual, sublingual tions which have been made to the present or suprahyoid thyroids. The developing

. time, it would seem that in association hyoid, by its entanglement with the thyroid with the parathyroid the thyroid gland may cause the central part to string out is an important factor in the control of into a pyramidial lobe. The midline calcium metabolism; that in asscociation cysts in this region are due to the thyroid's with the hypophysis, it is concerned in drawing embryonic mucosa into an anomthe development of the body; and that alous situation. together with the adrenals and the hypo- The thymus gland forms in two buds in physis, it serves to control blood pressure the third groove and in its descent may and circulation through the so-termed draw a portion of the thyroid into a subinternal secretion.

sternal position, as an accessory or aberrant While a relationship is thought, by some, thyroid. to exist between the thyroid and the pan- The thyroid gland, weighing from an creas, yet that connection is not well ounce to one and one-half ounces in the understood.

healthy adult, rests on either side of the That the thyroid is a sex gland is in- trachea to which it is firmly attached. It dicated by the fact that, in some inverte- is alveolar in structure and is lined with brates, it empties by a duct into the uterus. columnar cells. Over secretion is shown *Abstract of address of guest of honor at the 46th

by an increase of cells (parenchyma.) annual meeting of the Michigan State Medical Society Detroit, September 27, 28, 1911.

The quantity of colloid shows, to a degree,

1

the activity, or lack of it, in the vesicles. symptoms. Moebius' disease would be a betWhen in excess, it means simple or colloid ter term since Moebius first suggested, in goiter as retention cysts, and in great 1886, that the disease was caused by thyroid quantities it may, by pressure, destroy change and secretion. Hyperthyroidism the secreting cells. The area of arterial seems a reasonable term. It is a condition supply to the thyroid is approximately which can be present without sickness, that from the circle of Willis to the brain. yet which may become essentially toxic

The thyroid gland is found in all and cause death as a primary or chronic animals, and its study in them has thrown condition. considerable light upon the subject in The medical treatment of the disease general. The young of animals, without for the past 100 years has made little this gland, fail to develop and are called impression on the medical profession the cretins.

world over.

All forms of treatment, The simple, watery, colloid goiters of climatic, rest, internal and external mediadolescence are probably physiological, cation, have been and are still employed to a degree with the sex development. by men who are contemporaneous with The goiters of this period are respon- the older period of medicine, that is, before sive to medical treatment, seldom requir- we had any pathologic entity or knowledge ing operative relief.

of the real changes in the gland. The glands of the body are normally The early operation of ligation cures over-sized so that they may respond to many cases. Early as well as advanced excessive demands, or still be able to cases can be cured by partial thyroidectomy. secrete in sufficient amounts should they Very late cases, with degeneration of the be partially impaired at birth, or by heart, kidney, and liver, can be improved disease.

but not completely cured by partial The four epithelial bodies or parathyroids, thyroidectomy. The mortality in these although very small, are to be considered cases will vary from 1 to 4 per cent. Comas a part of the thyroid group. They bined operations are often indicated in are located behind the thyroid, developing bad cases; first ligating one or both superior in the third and fourth grooves of the vessel areas, and, later, doing a partial embryo. They are apparently often in- thyroidectomy. jured at birth by hemorrhage, yet seldom Local anesthesia is indicated in most develop tumors in later life. When ligations. Local or combined, or straight operating, these glands should be preserved ether anesthesia, are the methods used to prevent tetany.

for thyroidectomies, according to the Hydatid cysts, tuberculosis and malig- preference or experience of the individual nancy, both carcinoma and sarcoma, are operator. occasionally seen.

In 900 operations performed on the Morgagni's disease, Flajani's disease, thryoid in St. Mary's Hospital during the Parry's disease, Grave's disease, Basedow's first ten months of 1911, the mortality disease, exophthalmic goiter, etc., are was i per cent. merely terms to describe a group of irregular

THE CHOICE OF (OPERATION FOR THE RELIEF OF PROSTATIC |DYSURIA AND THE PRELIMINARY TREATMENT INDICATED.*

PAUL M. PILCHER, A, M., M. D.

Brooklyn, N. Y.

In reviewing the literature of prostatec- if not relieved by surgical operation, tomy, it is interesting to note that among would not only condemn the unfortunate the different methods of attacking the

owner of
the prostate to

a miserable prostate that have been practiced by and filthy invalidism, but most certainly, different surgeons, practically equally good in a relatively short period of time, would results

are reported by most diverse bring about the death of the patient. methods when used by men who have Sometimes I fear that the general become specially skilled in their applica- practitioner is still swayed in his judgment

The great relative frequency of by his experiences of a previous decade, obstructive prostatic dysuria, and the but let me assure him that the advances general recognition of the possibilities of made in this branch of surgery have been operative relief, will compel the frequent among the most tangible and brilliant, not attempt on the part of the general surgeon only in the relief of the urinary obstruction, to supply it, “So that the question is no but also in bringing about permanent relief longer what is possible in the hands of the from the mental and physical degeneraspecially expert, but what, in the light of tions associated with chronic prostatism. our present knowledge of the anatomical It is not alone the urinary obstruction relations and the pathological changes of which must be considered in these patients the prostate gland will, in the hands of the but also that which, to my mind, is equally average surgeon, most certainly and safely, important, the rehabilitation of the pawholly and permanently, relieve the ob- tient's self-respect, the rejuvenation of one structive dysuria that the prostatic disease prematurely aged, and the rekindling of a has produced.” (L. S. Pilcher).

mind clouded by the incomplete eliminaAny careful surgeon will probably have tion of toxic products, disordered by the a considerable series of favorable cases constant call for relief from his bladder, and without a death, but, sooner or later, he degraded and isolated from intellectual will meet with cases which demand surgical intercourse and association with his fellows relief and, despite the skill of the physician, on account of the unpleasant odor which terminate fatally, so that we must con- clings to his clothing, his irritable temper, tent ourselves with recovery in from 93% and the constant or frequent desire to to 95% of

This is, indeed, a

urinate. magnificent record, when we realize that If the patient survives his operation, the disease affects chiefly men between

the mental relief is sure to follow. As to the ages of 65 and 8o, and the disease, the complete and permanent cure of his *Read at the forty-sixth annual meeting of the

dysuria, we have found that in the great Michigan State Medical Society, Detroit, September 27, 28, 1911.

majority of cases that have been subjected

our cases.

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